KANIKSU LAND TRUST MEDICAL CONSENT & LIABILITY RELEASE

Medical Consent:  In the event of injury or other medical emergency, I DO HEREBY authorize the Kaniksu Land Trust (KLT) to arrange for such medical services as may be deemed reasonable and necessary to the welfare of such person(s), and I DO HEREBY release KLT from all liability in taking such action.  I acknowledge that KLT DOES NOT provide medical insurance for program participants and that any expense incurred is wholly the responsibility of the undersigned. I, the undersigned, have read this RELEASE AND CONSENT TO MEDICAL TREATMENT, and execute it voluntarily and with full knowledge of its significance.

Liability Release: I DO HEREBY agree to release and hold harmless KLT from liability for damages, except for personal injury or property damages caused by the gross negligence of KLT.  Kaniksu Land Trust (KLT) when used above includes the following: employees, paid contractors and volunteers. 

Participant(s) (print) ___________________________________________________________

Guardian’s Signature (if under the age of 18) __________________________Date__________

Media release: I authorize KLT to utilize any photographs or video which include myself and/or my child, taken during the activity, for KLT purposes. 

Signature____________________________________________________________________

Signature__________________________________________________ Date_____________